A Retrospective Study on Dextrose Prolotherapy for Unresolved Knee Pain at an Outpatient Charity Clinic in Rural IL

Authors: Ross A. Hauser, MD, Marion A. Hauser MS RD

The optimal long-term, symptomatic therapy for unresolved knee pain has not been established. Accordingly, we investigated the outcomes of patients undergoing Hackett-Hemwall dextrose Prolotherapy treatment for unresolved knee pain at a charity clinic in rural Illinois. Knee pain is a common problem facing many patients, presenting in up to 20% of the adult population.^[1] Currently in the U.S., osteoarthritis of the knee results in chronic knee pain in approximately 17 million people.^[2] According to the American Academy of Orthopaedic Surgeons, between the years 1998 and 2005, the number of knee replacements doubled, resulting in an estimated 533,808 procedures done in the year 2005.^[3] By the year 2030, this number is projected to be 3.48 million.^[4] With this one form of surgery already accruing over $17 billion in hospitalization charges in 2005, and 90% of these needing to be repeated in 10 years, we suggest that the Hackett-Hemwall dextrose Prolotherapy technique for treating the injured knee is a safe, effective, and less expensive solution to a portion of this rising trend.^[5,6]

Prolotherapy is becoming a widespread form of pain management in both complementary and allopathic medicine.^[7,8,9,10] Its primary use is in pain management associated with tendinopathies and ligament sprains in peripheral joints.^[11,12,13] Prolotherapy is also being used in the treatment of spine and joint degenerative arthritis.^[14,15] In double-blinded human studies, the evidence on the effectiveness of Prolotherapy has been considered promising, but mixed.^[16,17,18] Prolotherapy treatments are now done at some major medical centers and universities.^[19,20]

George S. Hackett, MD, Prolotherapy pioneer, coined the term Prolotherapy in the 1930s.^[21] As he described it, “The treatment consists of the injection of a solution within the relaxed ligament and tendon which will stimulate the production of new fibrous tissue and bone cells that will strengthen the ‘weld’ of fibrous tissue and bone to stabilize the articulation and permanently eliminate the disability.”^[22] Animal studies have shown that Prolotherapy induces the production of new collagen by stimulating the normal inflammatory reaction.^[23,24] In addition, animal studies have shown improvements in ligament and tendon diameter and strength.^[25,26] Human studies have shown improvements in pain symptoms.^[27,28]

Studies on the effectiveness of Prolotherapy on knee pain have been promising.^[29,30] One of these studies showed the benefits of three bimonthly injections of dextrose as the proliferant into the degenerated knees.^[31] To evaluate the effectiveness of dextrose Prolotherapy, not just on knee pain but on quality of life measures, this observational study was undertaken.

Objectives
To investigate the outcomes of patients undergoing dextrose Prolotherapy treatment for unresolved knee pain at a charity clinic in rural Illinois. To develop selection criterion for who might be a good candidate for Prolotherapy in patients with unresolved knee pain.

Methods
Patients with unresolved knee pain who were treated with dextrose Prolotherapy every three months were included into an observational study. The patients were called on the phone, on average, fifteen months following their last Prolotherapy session and asked to answer detailed questions related to the level of knee pain, stiffness, range of motion, medication usage, anxiety, depression, activities of daily living, and other quality of life measures before and after receiving dextrose Prolotherapy.

Results
A total of 80 patients representing 119 knees were treated in 2003-2005. The average starting knee pain level was 6.5 and ending knee pain level was 2.3. Using the matched sample test, statistically significant improvements in pain, stiffness, and crunching sensation were observed. Ninetyfive percent of patients exhibited improvements in their pain levels after treatment with Prolotherapy. Long term improvements in stiffness occurred in 99% of patients. Ninety percent of patients were able to decrease their medication usage by 50% or more. More than 87% of patients were able to decrease their additional pain treatments by 50% or more. Anxiety and depression symptoms were present in 49% and 41% before Prolotherapy and only in 15% and 10%, respectively, after Prolotherapy. Ninety percent of patients who were told, prior to receiving Prolotherapy, that surgery was their only option, had 75% or greater relief of their chronic pain. While no patients stated they could walk normally before Prolotherapy, 65% stated they could walk normally after Prolotherapy. Ninety-six percent of patients felt Prolotherapy improved their life overall.

Conclusions
In this observational study, patients with unresolved knee pain reported clinically relevant improvements in their pain levels and quality of life after receiving dextrose Prolotherapy.